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Published October 2005
Summary | Table of Contents | Read online
Health technology has the tremendous potential to change our understanding of disease, transform the delivery of health-care services, and improve health outcomes. But using such technology comes at a price. Decisions about whether to purchase and use new technology should be based on high-quality evidence on its impact on health care and health outcomes.
OECD countries face the challenge of aligning health-care decision making with the best available evidence. While many countries have invested in the production of health technology assessment, evidence about its use in decision making is limited.
Health Technologies and Decision Making analyses the barriers to, and facilitators of, evidence-based decision making in OECD health-care systems. It examines how countries can successfully manage the opportunities and challenges arising from health-related technology by optimising decision-making processes, recognising the value of innovation,dealing with uncertainty, and producing and co-ordinating health technology assessment. The book also considers the capacity of health systems to respond to the particular challenges of fast-developing health-related biotechnologies.
The introduction of new technologies has brought remarkable improvements over the past few decades to the health of the citizens of OECD member countries. There is, however, widespread variation in how such new, as well as existing, technologies are used across OECD countries, indicating that the most effective and efficient technologies may not always be the ones employed. Encouraging the uptake of the most efficient and effective health-care technologies remains a significant policy challenge in many OECD countries.
The work described in this report, carried out with a group of experts drawn from OECD countries, examined how improvements could be made to integrate effective and efficient technologies into health-care systems. Analysis focused on the production of evidence, primarily in the form of health technology assessment (HTA), and the way that such evidence is subsequently used in decision making. The way decisions are made and implemented was also analysed, including examining the range of policy tools used to put decisions into actual practice.
The conclusions presented in this report drew on analysis of a survey of how health technologies are integrated into health systems, focusing on:
- How decisions at the national, regional and hospital levels are made.
- How evidence (particularly HTA-based evidence) is produced and used in decision making.
- How aspects of health-care systems facilitate or impede the implementation of decisions.
Table of Contents
Chapter 1 - Introduction
Health-care technologies have contributed to the extension of human life and to the reduction of pain, disease risk, and disability. However, there is widespread variation in the uptake and diffusion of health-care technology amongst OECD countries, indicating that there are opportunities for more effective integration of such technologies into the health system. This introductory chapter sets out the objectives and methodology for the OECD project on health technologies. It also presents readers with the concepts and definitions used throughout the book.
Chapter 2 - Innovation and Integration of Health Technologies: A Review of the Issues and Literature
Medical innovation does not just appear. There are important interactions between OECD health-care systems and R&D that shape the speed and direction of medical advances. This chapter provides a literature review on the dynamics of health technology innovation and the mechanisms that affect health technology uptake and diffusion. It also critically examines the literature related to the policy tools used in a number of OECD countries to help manage the integration of technology into the health-care system.
Chapter 3 - The Production of Health Technology Assessment: An Analysis of Survey Results
The information produced by health technology assessment (HTA) can be used to enhance decisions about the use and diffusion of technology. This chapter presents results from the OECD survey on health technologies and provides information on how HTA is undertaken as well as its purpose, target audience and content. The methods used to disseminate the results of HTA are examined and a comparative picture is presented of national differences in the production of HTA.
Chapter 4 - Decision Making and Implementation: An Analysis of Survey Results
Health-care decisions have an important impact on the use and uptake of health technologies in OECD countries. This chapter presents results from the OECD survey on health technologies, which focused on decision-making processes and implementation methods in survey countries. It considers the policy tools that countries use to implement evidence-based decision making and reports on the main impediments and facilitators within the health-care system for implementing decisions. The chapter also describes how various countries have successfully integrated technologies into their health systems in line with evidence and health system objectives.
Chapter 5 - The Use of Health Technology Assessment in the Health-Care System: Lessons From Three OECD Countries
Health-care systems play an important role in determining how decision makers use the information provided through health technology assessment. This chapter looks at how three OECD health-care systems (Canada, Mexico and Australia) are dealing with the challenge of effectively adapting and incorporating HTA into their respective decision-making structures. Whilst the approaches differ markedly, each country’s efforts are anchored to the institutional, organisational and cultural features of the health-care system.
Chapter 6 - Health-Care Evaluation: Issues in Transferability
This chapter examines the challenges of evidence-based decision making within health-care systems and identifies the potential pitfalls that decision makers face in transferring results from economic evaluations from one setting to another. It sets out three possible areas for policy consideration that may help deal with these pitfalls, including an agenda for improving the dialogue between the analytical enterprise and policy communities.
Chapter 7 - Managing Decision Making Under Uncertainty: Perspectives From a Central Administrator
Uncertainty is pervasive in health-care decision making and arises when there is insufficient definitive information to make informed choices. This chapter examines the challenges that decision makers have to confront when faced with uncertainty. Its focus is on the administrative contexts of decision making and provides some available approaches for managing uncertainty within that context.
Chapter 8 - Policy Decision Making in the Field of Biomedicine
Health-related biotechnology is developing at unprecedented speed and is delivering new techniques for preventing, treating and managing disease, but there is an extensive debate about the use of some of these new technologies. This chapter examines the specific challenges for policy makers and assessors of some of these technologies. It also sets out the additional considerations to make more informed decisions as well as current shortfalls in providing this information. Finally, this chapter suggests some instruments that may fill these gaps.
Chapter 9 - Conclusions
Health-care innovation has transformed the practice of medicine over the course of the last century. Technological innovations can bring substantial benefits in the prevention, diagnosis and treatment of disease, as well as access to care. At the same time, there is widespread variation in the use of health-care technologies across OECD countries, indicating that the most effective and efficient technologies may not always be the ones most often used. Encouraging the uptake of efficient and effective health-care technologies is a significant policy challenge in many OECD countries.